Provider Demographics
NPI:1215480447
Name:EXPRESS HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:EXPRESS HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, MS
Authorized Official - Phone:646-752-2642
Mailing Address - Street 1:65 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5709
Mailing Address - Country:US
Mailing Address - Phone:516-986-5429
Mailing Address - Fax:516-825-0112
Practice Address - Street 1:65 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5709
Practice Address - Country:US
Practice Address - Phone:516-986-5429
Practice Address - Fax:516-825-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56004928152WL0500X
NY231060207R00000X
NY2338331208000000X
NY0165601246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical TechnologistGroup - Multi-Specialty